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Age
 
 
 
Gender:
 
Male
 
Female
 
Other
 
 
 
 
State of residence
 
 
 
Political Affiliation
   
 
 
 
Religious Affiliation:
   
 
 
 
Do you have children?
 
Yes
 
No
 
 
 
Have you received the Gardasil vaccine?
 
Yes
 
No
 
N/A
 
 
 
If so, how many?
 
1
 
2
 
3
 
4
 
Other
 
 
 
 
How do you think the vaccine works?
   
 
 
 
Who should have access to the vaccine?